PMID- 38006415 OWN - NLM STAT- MEDLINE DCOM- 20240305 LR - 20240305 IS - 2366-0058 (Electronic) VI - 49 IP - 3 DP - 2024 Mar TI - Photon-counting CT urogram: optimal acquisition potential (kV) determination for virtual noncontrast creation. PG - 868-874 LID - 10.1007/s00261-023-04113-7 [doi] AB - PURPOSE: To quantitatively and qualitatively compare the degree of iodine removal in the collecting system from PCCT urographic phase-derived virtual noncontrast (VNC) images obtained at 140 kV versus 120 kV. METHODS: A retrospective PACS search identified adult patients (>18 years) who underwent a PCCT urogram for hematuria from 4/2022 to 4/2023 with available urographic phase-derived VNC images in PACS. Tube voltage (120 kV, 140 kV), body mass index, CTDIvol, dose length product (DLP), and size-specific dose estimate (SSDE) were recorded. Hounsfield Unit (HU) in both renal pelvises and the urinary bladder on urographic-derived VNC were recorded. Three radiologists qualitatively assessed the degree of iodine removal (renal pelvis, urinary bladder) and diagnostic confidence for urinary stone detection. Continuous variables were compared for 140 kV versus 120 kV with the Wilcoxon rank sum test. A p < .05 indicated statistical significance. RESULTS: 63 patients (34 male; median (Q1, Q3) age: 30 (26, 34) years; 140 kV/120 kV: 30 patients/33 patients) were included. BMI, CTDIvol, DLP, and SSDE were not different for 140 kV and 120 kV (all p > .05). Median (Q1, Q3) collecting system HU (renal pelvis and bladder) was 0.9 (- 3.6, 4.4) HU at 140 kV and 10.5 (3.6, 26.7) HU at 120 kV (p = .04). Diagnostic confidence for urinary calculi was 4.6 [1.1] at 140 kV and 4.1 [1.4] at 120 kV (p = .005). Diagnostic confidence was 5/5 (all readers) in 82.2% (74/90) at 140 kV and 59.6% (59/99) at 120 kV (p < .001). CONCLUSION: PCCT urographic phase-derived VNC images obtained at 140 kV had better collecting system iodine removal than 120 kV with similar patient radiation exposure. With excellent PCCT urographic phase iodine removal at 140 kV, consideration can be made to utilize a single-phase CT urogram in young patients. CI - (c) 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Dane, Bari AU - Dane B AUID- ORCID: 0000-0003-2205-3309 AD - Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. Bari.Dane@nyulangone.org. FAU - Freedman, Daniel AU - Freedman D AD - Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. FAU - Qian, Kun AU - Qian K AD - Department of Biostatistics, NYU Langone Health, 180 Madison Avenue, New York, NY, 10016, USA. FAU - Ginocchio, Luke AU - Ginocchio L AD - Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. FAU - Smereka, Paul AU - Smereka P AD - Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. FAU - Megibow, Alec AU - Megibow A AD - Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. LA - eng PT - Journal Article DEP - 20231125 PL - United States TA - Abdom Radiol (NY) JT - Abdominal radiology (New York) JID - 101674571 RN - 9679TC07X4 (Iodine) SB - IM MH - Adult MH - Humans MH - Male MH - Retrospective Studies MH - *Radiography, Dual-Energy Scanned Projection/methods MH - Tomography, X-Ray Computed/methods MH - *Urinary Calculi MH - *Iodine OTO - NOTNLM OT - CT urogram OT - Photon-counting CT OT - Virtual noncontrast OT - Virtual unenhanced EDAT- 2023/11/26 07:42 MHDA- 2024/03/05 06:47 CRDT- 2023/11/25 11:03 PHST- 2023/09/08 00:00 [received] PHST- 2023/10/23 00:00 [accepted] PHST- 2023/10/18 00:00 [revised] PHST- 2024/03/05 06:47 [medline] PHST- 2023/11/26 07:42 [pubmed] PHST- 2023/11/25 11:03 [entrez] AID - 10.1007/s00261-023-04113-7 [pii] AID - 10.1007/s00261-023-04113-7 [doi] PST - ppublish SO - Abdom Radiol (NY). 2024 Mar;49(3):868-874. doi: 10.1007/s00261-023-04113-7. Epub 2023 Nov 25.